Open reduction and internal fixation combined with hinged elbow fixator in capitellum and trochlea fractures

Acta Orthop. 2010 Apr;81(2):228-33. doi: 10.3109/17453671003685475.

Abstract

Background and purpose: The current surgical treatment for displaced fracture of the capitellum and trochlea is open reduction and internal fixation (ORIF), but the results are often unsatisfactory, particularly with complex fractures. Furthermore, the surgical approach, the kind of osteosynthesis, and postoperative management are controversial. We evaluated the results of internal fixation combined with hinged external fixation.

Methods: We analyzed 15 patients with a mean age of 47 (18-65) years. Based on the Bryan-Morrey-McKee classification, the fractures were identified as type I in 6 cases and type IV in 9. Active and passive motion was started and activities of daily living were permitted on the second postoperative day. The mean follow-up time was 29 (12-49) months.

Results: In 13 cases, functional range of motion was obtained within 6 weeks of surgery. At final follow-up, 14 patients had a stable, pain-free elbow with a mean active range of motion of 13 degrees to 140 degrees . The average score on the Mayo elbow performance score was 98.

Interpretation: The use of the hinged fixator allows early motion of the elbow while preserving joint stability. It may have additional value in complex articular fractures when stable internal fixation cannot be obtained with ORIF, and in the presence of severe ligamentous injuries.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Elbow Joint / physiopathology*
  • External Fixators*
  • Female
  • Follow-Up Studies
  • Fracture Fixation, Internal / instrumentation
  • Fracture Fixation, Internal / methods*
  • Fracture Healing
  • Humans
  • Humeral Fractures / diagnostic imaging
  • Humeral Fractures / surgery*
  • Male
  • Middle Aged
  • Radiography
  • Radius Fractures / diagnostic imaging
  • Radius Fractures / surgery*
  • Range of Motion, Articular
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult